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Emilson, C., Demmelmaier, I., Bergman, S., Lindberg, P., Denison, E. & Åsenlöf, P. (2017). A 10-year follow-up of tailored behavioural treatment and exercise-based physiotherapy for persistent musculoskeletal pain. Clinical Rehabilitation, 31(2), 186-196
Open this publication in new window or tab >>A 10-year follow-up of tailored behavioural treatment and exercise-based physiotherapy for persistent musculoskeletal pain
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2017 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, no 2, p. 186-196Article in journal (Refereed) Published
Abstract [en]

Objective: To study the long-term outcomes of two interventions targeting patients with sub-acute and persistent pain in a primary care physiotherapy setting. Design: A 10-year follow-up of a two-armed randomised controlled trial, initially including 97 participants. Interventions: Tailored behavioural medicine treatment, applied in a physiotherapy context (experimental condition), and exercise-based physiotherapy (control condition). Main measures: Pain-related disability was the primary outcome. The maximum pain intensity, pain control, fear of movement, sickness-related absence (register data) and perceived benefit and confidence in coping with future pain problems were the secondary outcomes. Results: Forty-three (44%) participants responded to the follow-up survey, 20 in the tailored behavioural medicine treatment group and 23 in the exercise-based physiotherapy group. The groups did not differ in terms of the change in the scores for the primary outcome (p=0.17) of pain-related disability between the experimental group (median: 2.5, Q1-Q3: -2.5-14.25), and the control group (median: 0, Q1-Q3: -5-6). Further, there were also no significant differences found for the secondary outcomes except for sickness-related absence, where the exercise-based physiotherapy group had more days of sickness-related absence three months before treatment (p= 0.02), and at the 10-year follow-up (p=0.03). Discussion: The beneficial effects favouring tailored behavioural medicine treatment that observed post-treatment and at the two-year follow-up were not maintained 10 years after treatment.

Keywords
behavioural medicine, Chronic pain, long-term compliance, physical exercise, primary care
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-34888 (URN)10.1177/0269215516639356 (DOI)000394758500005 ()27009057 (PubMedID)2-s2.0-85011556230 (Scopus ID)
Available from: 2017-02-16 Created: 2017-02-16 Last updated: 2018-10-16Bibliographically approved
Cederbom, S., Denison, E. & Bergland, A. (2017). A behavioral medicine intervention for community-dwelling older adults with chronic musculoskeletal pain: Protocol for a randomized controlled trial. Journal of Pain Research, 10, 845-853
Open this publication in new window or tab >>A behavioral medicine intervention for community-dwelling older adults with chronic musculoskeletal pain: Protocol for a randomized controlled trial
2017 (English)In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 10, p. 845-853Article in journal (Refereed) Published
Abstract [en]

Background: Chronic musculoskeletal pain is a major health problem among older adults, particularly those who live alone and/or those who are dependent on formal care. Chronic pain is associated with mobility problems, falls, fear of falling, catastrophizing thoughts, and a lower quality of life. Research shows that physical therapy interventions based on behavioral medicine approaches are beneficial for middle-aged adults with chronic pain. However, there appears to be no previous randomized controlled trials (RCTs) based on this theoretical framework that have examined the effect on older adults with chronic musculoskeletal pain who live alone at home and are dependent on formal care to manage their everyday lives. The aim of the planned study is to evaluate the effect of an individually tailored integrated physical therapy intervention based on a behavioral medicine approach compared with the effect of standard care. Methods/design: The planned study is an RCT that will include one intervention and one control group involving a total of 150 adults aged ≥75 years with chronic musculoskeletal pain who live alone at home and are dependent on formal care to manage their everyday lives. The intervention will involve a 12-week home-based individually tailored intervention that will be designed to enhance the participants’ ability to perform everyday activities by improving physical function and reducing pain-related disability and beliefs. The control group will be given standard care, including general advice about physical activity. The participants will be assessed at baseline and at 3 and 6 months after baseline. The primary outcome will be pain-related disability and physical performance. Discussion: The intervention, if effective, will have the potential to be the basis of the first evidence-based guidelines for physical therapists who work with older adults with chronic musculoskeletal pain. 

Place, publisher, year, edition, pages
Dove Medical Press Ltd., 2017
Keywords
Fall, Fear of falling, Independence, Physical activity, Quality of life, Self-efficacy, ADL disability, Article, behavioral medicine, chronic pain, community care, controlled study, daily life activity, evidence based medicine, female, health belief, human, individualization, intermethod comparison, major clinical study, male, methodology, musculoskeletal pain, Norway, patient compliance, patient counseling, physical performance, physiotherapy, practice guideline, randomized controlled trial, treatment duration, treatment outcome
National Category
Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-35341 (URN)10.2147/JPR.S129648 (DOI)000398848300001 ()28435321 (PubMedID)2-s2.0-85018515451 (Scopus ID)
Available from: 2017-05-19 Created: 2017-05-19 Last updated: 2018-10-16Bibliographically approved
Cederbom, S., Thunborg, C., Denison, E., Söderlund, A. & von Heideken Wågert, P. (2017). Home Help Service Staffs' Descriptions of Their Role in Promoting Everyday Activities Among Older People in Sweden Who Are Dependent on Formal Care.. Journal of Applied Gerontology, 36(8), 971-992
Open this publication in new window or tab >>Home Help Service Staffs' Descriptions of Their Role in Promoting Everyday Activities Among Older People in Sweden Who Are Dependent on Formal Care.
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2017 (English)In: Journal of Applied Gerontology, ISSN 0733-4648, E-ISSN 1552-4523, Vol. 36, no 8, p. 971-992Article in journal (Refereed) Published
Abstract [en]

The study aimed to explore how home help service staff described their role in improving the abilities of older people, in particular, older women with chronic pain who are dependent on formal care, to perform everyday activities. Three focus group interviews were conducted, and a qualitative inductive thematic content analysis was used. The analysis resulted in one theme: struggling to improve the care recipients' opportunities for independence but being inhibited by complex environmental factors. By encouraging the care recipients to perform everyday activities, the staff perceived themselves to both maintain and improve their care recipients' independence and quality of life. An important goal for society and health care professionals is to improve older people's abilities to "age in place" and to enable them to age independently while maintaining their quality of life. A key resource is home help service staff, and this resource should be utilized in the best possible way.

Keywords
dependency, focus group interviews, home help service staff, independency, older people, qualitative study, quality of life, rehabilitation, team
National Category
Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-29398 (URN)10.1177/0733464815595511 (DOI)000404415600004 ()26209706 (PubMedID)2-s2.0-85021438772 (Scopus ID)
Available from: 2015-10-27 Created: 2015-10-27 Last updated: 2018-01-30Bibliographically approved
Cederbom, S., Rydwik, E., Söderlund, A., Denison, E., Frandin, K. & Petra, v. H. (2014). A behavioral medicine intervention for older women living alone with chronic pain - a feasibility study. Clinical Interventions in Aging, 9, 1383-1397
Open this publication in new window or tab >>A behavioral medicine intervention for older women living alone with chronic pain - a feasibility study
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2014 (English)In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 9, p. 1383-1397Article in journal (Refereed) Published
Abstract [en]

Background: To be an older woman, live alone, have chronic pain, and be dependent on support are all factors that may have an impact on daily life. One way to promote ability in everyday activities in people with pain-related conditions is to use individualized, integrated behavioral medicine in physical therapy interventions. How this kind of intervention works for older women living alone at home, with chronic pain, and dependent on formal care to manage their everyday lives has not been studied. The aim was to explore the feasibility of a study and to evaluate an individually tailored integrated behavioral medicine in physical therapy intervention for the target group of women. Materials and methods: The study was a 12-week randomized trial with two-group design. Primary effect outcomes were pain-related disability and morale. Secondary effect outcomes focused on pain-related beliefs, self-efficacy for exercise, concerns of falling, physical activity, and physical performance. Results: In total, 23 women agreed to participate in the study and 16 women completed the intervention. The results showed that the behavioral medicine in physical therapy intervention was feasible. No effects were seen on the primary effect outcomes. The experimental intervention seemed to improve the level of physical activity and self-efficacy for exercise. Some of the participants in both groups perceived that they could manage their everyday life in a better way after participation in the study. Conclusion: Results from this study are encouraging, but the study procedure and interventions have to be refined and tested in a larger feasibility study to be able to evaluate the effects of these kinds of interventions on pain-related disability, pain-related beliefs, self-efficacy in everyday activities, and morale in the target group. Further research is also needed to refine and evaluate effects from individualized reminder routines, support to collect self-report data, safety procedures for balance training, and training of personnel to enhance self-efficacy.

National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-25924 (URN)10.2147/CIA.S66943 (DOI)000340614200002 ()25170262 (PubMedID)2-s2.0-84907300536 (Scopus ID)
Available from: 2014-09-12 Created: 2014-09-12 Last updated: 2018-10-25Bibliographically approved
Cederbom, S., Söderlund, A., Denison, E. & von Heideken Wågert, P. (2014). Chronic pain among older women living alone. A study focusing on disability and morale.. European Journal of Physiotherapy, 16(3), 139-150
Open this publication in new window or tab >>Chronic pain among older women living alone. A study focusing on disability and morale.
2014 (English)In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 16, no 3, p. 139-150Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate 1)how older women who are living alone perceive chronic musculoskeletal pain,Activities of Daily Living (ADL), physical activity, affective distress,pain-related beliefs, pain management, and rate pain-related disability andmorale,  2) the relationships betweendemographic variables, ADL, physical activity, affective distress, pain-relatedbeliefs, and pain management with pain-related disability and morale.Method: The study had across-sectional and correlational design. Sixty women, living alone with chronicpain and community support aged ≥65 years were included.Results: The women were on average 81 years old and had lived with pain forabout 21.5 years. They reported low scores of affective distress,catastrophizing thoughts and self-efficacy, high scores of fear of movement,low degrees of pain-related disability, and low levels of  morale. The multiple regression analysisshowed that only catastrophizing thoughts significantlyexplained the variation in pain-related disability, and both affective distress and catastrophizing thoughtssignificantly explained the variation in morale. Conclusion: These older women livingalone with chronic pain reported similar prevalence ofchronic pain and pain-related disability but lower morale when comparingthe results with similar studies about older people in the same age group orolder people who are in need of help to manage their daily life. The only variable that was independely associated to bothpain-related disability and morale was catastrophizing. Further researchshould focus on identifying catastrophizing thougts,and also on developing a rehabilitation program based on a biopsychosocialperspective with the goal to decrease catastrophizing, pain-relateddisability, and increase morale for this target group

National Category
Medical and Health Sciences
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-26586 (URN)2-s2.0-84906501377 (Scopus ID)
Available from: 2014-11-19 Created: 2014-11-19 Last updated: 2018-01-26Bibliographically approved
Overmeer, T., Boersma, K., Denison, E. & Linton, S. (2011). Does teaching physical therapists to deliver a biopsychosocial treatment program result in better patient outcomes?: A randomized controlled trial. Physical Therapy, 91(5), 804-819
Open this publication in new window or tab >>Does teaching physical therapists to deliver a biopsychosocial treatment program result in better patient outcomes?: A randomized controlled trial
2011 (English)In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 91, no 5, p. 804-819Article in journal (Refereed) Published
Abstract [en]

Background. Psychosocial prognostic factors are important in the development of chronic pain, but treatment providers often lack knowledge and skills to assess and address these risk factors. Objective. The aim of this study was to examine the effects on outcomes (pain and disability) in patients of a course about psychosocial prognostic factors for physical therapists. Design. This study was a randomized, controlled trial. Setting. The setting was primary care practice. Participants. Forty-two primary care physical therapists attended an 8-day university course (over 8 weeks) aimed at identifying and addressing psychosocial risk factors. Intervention. The physical therapists were randomly assigned to either the course or a waiting list. They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course. Measurements. We measured physical therapists' attitudes and beliefs about psychosocial factors, knowledge, and skills before and after the course. We measured patients' pain, disability, catastrophizing, and mood at the start of treatment and at a 6-month follow-up. Methods. The physical therapists were randomly assigned to either the course or a waiting list. They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course. Results. Pain and disability outcomes in all patients of physical therapists who had participated in the course or in patients at risk of developing long-term disability who had higher levels of catastrophizing or depression were not significantly different from those outcomes in patients of physical therapists who had not participated in the course. Pain and disability outcomes in patients with a low risk of developing long-term disability-and pain outcomes in patients with a high risk of developing long-term disability-were not dependent upon whether the attitudes and beliefs of their physical therapists changed during the course. However, disability outcomes in patients with a high risk of developing long-term disability may have been influenced by whether the attitudes and beliefs of their physical therapists changed. Limitations. A limitation of this study was that actual practice behavior was not measured. Conclusions. An 8-day university course for physical therapists did not improve outcomes in a group of patients as a whole or in patients with a risk of developing long-term disability. However, patients who had a risk of developing long-term disability and had higher levels of catastrophizing or depression may have shown greater reductions in disability if the attitudes and beliefs of their physical therapists changed during the course.

National Category
Medical and Health Sciences Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-13914 (URN)10.2522/Ptj.20100079 (DOI)000289961000020 ()2-s2.0-79960955694 (Scopus ID)
Available from: 2012-01-03 Created: 2012-01-03 Last updated: 2017-12-08Bibliographically approved
Nilsson, A., Denison, E. & Lindberg, P. (2011). Life values as predictors of pain, disability and sick leave among Swedish registered nurses: A longitudinal study. BMC Nursing, 10(art nr 17)
Open this publication in new window or tab >>Life values as predictors of pain, disability and sick leave among Swedish registered nurses: A longitudinal study
2011 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, BMC Nursing, Vol. 10, no art nr 17Article in journal (Refereed) Published
Abstract [en]

Background: Prospective studies on high-risk populations, such as subgroups of health care staff, are limited, especially prospective studies among staff not on sick-leave. This paper is a report of a longitudinal study conducted to describe and compare the importance and consistency of life domains among registered nurses (RNs) working in a Swedish hospital and evaluate a model based on the consistency of valued life domains for prediction of pain, disability and sick leave.Method: Importance and consistency ratings of life values, in 9 domains, were collected during 2003 and 2006 from 196 RNs using the Valued Living Questionnaire (VLQ). Logistic regression analyses were used for prediction of pain, disability and sick leave at the three-year follow-up. The predictors family relations, marriage couples/intimate relations, parenting, friends/social life, work, education, leisure time, psychological well-being, and physical self-care were used at baseline.Results: RNs rated life values regarding parenting as most important and with the highest consistency both at baseline and at follow-up. No significant differences were found between RNs' ratings of importance and consistency over the three-year period, except for friends/social relations that revealed a significant decrease in importance at follow-up. The explanatory models for pain, disability and sick leave significantly predicted pain and disability at follow-up. The odds of having pain were significantly increased by one consistency rating (psychological well-being), while the odds were significantly decreased by physical self-care. In the model predicting disability, consistency in psychological well-being and education significantly increased the odds of being disabled, while consistency in physical self-care significantly decreased the odds.Conclusion: The results suggest that there might be a link between intra-individual factors reflecting different aspects of appraised life values and musculoskeletal pain (MSP).

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mdh:diva-15747 (URN)10.1186/1472-6955-10-17 (DOI)2-s2.0-80053175450 (Scopus ID)
Available from: 2012-10-24 Created: 2012-10-24 Last updated: 2017-12-07Bibliographically approved
Sandborgh, M., Lindberg, P., Åsenlöf, P. & Denison, E. (2010). Implementing behavioural medicine in physiotherapy treatment: Part I: Clinical trial. Advances in Physiotherapy, 12(1), 2-12
Open this publication in new window or tab >>Implementing behavioural medicine in physiotherapy treatment: Part I: Clinical trial
2010 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 12, no 1, p. 2-12Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the capacity of the Pain Belief Screening Instrument (PBSI) to discriminate between subgroups for targeting of treatment, investigate effects of treatment tailored to patients' individual and functional goals, and identify a suitable treatment dosage for patients with low risk of disability. Explorative study, Part I. Design: Randomized, controlled clinical trial with four treatment conditions. Methods: Patients in primary healthcare (n=45) with musculoskeletal pain for ≥4 weeks were included. PBSI-identified subgroups were validated by comparing scores on four established instruments. Measures of disability and patients' ratings of global outcome were used to examine treatment effect. Results: PBSI data adequately defined patients with either high or low risk of disability. Patients in the tailored treatment rated global outcome as better than in the non-tailored treatment. No differences were found on disability measures. For the low-risk group, the brief tailored treatment was as effective as the non-targeted control treatment. Conclusion: The PBSI adequately defined subgroups. Tailored treatment was partially superior to physical exercise treatment. Targeting by treatment dosage was effective for low-risk patients but remains to be investigated for high-risk patients. Treatment integrity for tailored treatments was compromised and is to be further explored in the following study.

Keywords
Pain, PBSI, primary healthcare, screening, tailored treatment
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mdh:diva-11157 (URN)10.3109/14038190903480664 (DOI)2-s2.0-77749315523 (Scopus ID)
Available from: 2010-11-24 Created: 2010-11-24 Last updated: 2017-12-12Bibliographically approved
Sandborgh, M., Åsenlöf, P., Lindberg, P. & Denison, E. (2010). Implementing behavioural medicine in physiotherapy treatment: Part II: Adherence to treatment protocol. Advances in Physiotherapy, 12(1), 13-23
Open this publication in new window or tab >>Implementing behavioural medicine in physiotherapy treatment: Part II: Adherence to treatment protocol
2010 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 12, no 1, p. 13-23Article in journal (Refereed) Published
Abstract [en]

Objectives: In a controlled clinical trial, targeted and tailored treatment strategies, based on cognitive–behavioural treatment principles were investigated. The intervention was aimed at patients with persistent musculoskeletal pain in primary healthcare. A preliminary examination indicated low treatment integrity for the tailored treatment. Therefore, the aim in this study was to evaluate physiotherapists' treatment adherence to a treatment tailored to physical, cognitive and behavioural factors of importance for the performance of patients' prioritized activities. Explorative study, Part II. Materials and Methods: Treatment documents for 18 patients, treated by four specially trained physiotherapists, were utilized for assessment of treatment adherence. A treatment integrity measure was developed, tested and used for evaluation of adherence to the treatment protocol. Results: Physiotherapists' adherence to the treatment manual was low concerning treatment components and the overall sequencing of the treatment. Intrapersonal physical and cognitive factors, and situational variations tied to the performance of prioritized activities targeted in treatment, were rarely found or specified in treatment documents. Statements about functional and causal relationships between determinants for activity performance were not documented or unspecified. Conclusion: The physiotherapists' adherence to the treatment protocol was low despite the pre-intervention training programme and supervision during the intervention period.

Keywords
Cognitive-behavioural, therapist training, treatment adherence, treatment integrity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mdh:diva-11156 (URN)10.3109/14038190903480672 (DOI)2-s2.0-77749308389 (Scopus ID)
Available from: 2010-11-24 Created: 2010-11-24 Last updated: 2017-12-12Bibliographically approved
Nilsson, A., Lindberg, P. & Denison, E. (2010). Predicting of pain, disability, and sick leave regarding a non-clinical sample among Swedish nurses. Scandinavian Journal of Pain, 1(3), 160-166
Open this publication in new window or tab >>Predicting of pain, disability, and sick leave regarding a non-clinical sample among Swedish nurses
2010 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 1, no 3, p. 160-166Article in journal (Refereed) Published
Abstract [en]

Objectives: Health care providers, especially registered nurses (RNs), are a professional group with a high risk of musculoskeletal pain (MSP). This longitudinal study contributes to the literature by describing the prevalence and change in MSP, work-related factors, personal factors, self-reported pain, disability and sick leave (>7 days) among RNs working in a Swedish hospital over a 3-year period. Further, results concerning prediction of pain, disability and sick leave from baseline to a 3-year follow-up are reported. Method: In 2003, a convenience sample of 278 RNs (97.5% women, mean age 43 years) completed a questionnaire. In 2006, 244 RNs (88% of the original sample) were located, and 200 (82%) of these completed a second questionnaire. Results: Logistic regression analyses revealed that pain, disability and sick leave at baseline best predicted pain, disability, and sick leave at follow-up. The personal factors self-rated health and sleep quality during the last week predicted pain at follow-up, while age, self-rated health, and considering yourself as optimist or pessimist predicted disability at follow-up, however weakly. None of the work-related factors contributed significantly to the regression solution. Conclusions: The results support earlier studies showing that a history of pain and disability is predictive of future pain and disability. Attention to individual factors such as personal values may be needed in further research. 

Keywords
Disability, Musculoskeletal pain, Personal factors, Registered nurses, Sickness absence, Work-related factors, analgesic agent, article, backache, female, follow up, health, hospital, human, longitudinal study, low back pain, major clinical study, male, marriage, medical leave, neck pain, nurse, priority journal, questionnaire, self report, shoulder pain, sleep
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mdh:diva-20509 (URN)10.1016/j.sjpain.2010.05.029 (DOI)29913982 (PubMedID)2-s2.0-77955045230 (Scopus ID)
Available from: 2013-07-30 Created: 2013-07-30 Last updated: 2019-06-18Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5064-8820

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